I spent a cheery hour or two last week enjoying PAHO's celebration of programs throughout the Americas designed to empower women and improve their health. I was particularly taken with their tactic of gently handing speakers a rose when they went over their allocated time. But I could have listened for much longer to a jolly and thought provoking Uruguay Ministry of Health official.
He was talking about Uruguay's efforts to address the government's conflict between the fact that abortion was against the law, and the fact that an astounding 29% of women who had illegal abortions were dying of the complications. In explaining their approach, he said something that got me wondering: 'battling for all or nothing is the best way for nothing to change'.
His words made me think of Twitter's fairly recent and controversial initiative to enable country-specific censorship of its content. I've read basically the same argument from Twitter: compromise now will improve things little by little, and lay the foundations to incrementally drive wider social progress and development.
In the case of Uruguay abortion law, it seems to be working. Their innovative women's health program trains abortion providers in safer practices, ensures confidentiality, and provides community outreach and education including family planning counseling and pre- and post-abortion counseling to help vulnerable women make informed decisions. Abortions are still illegal in Uruguay, but this program is not - in fact, I'm told its provision is now part of the law. It has helped acknowledge and address the public health challenge of unsafe abortions, and has reportedly reduced maternal deaths, bringing Uruguay a step closer to achieving one of the Millennium Development Goals. Not bad for what the Uruguay official acknowledges is a compromise.
In the case of Twitter's position, I'm not sure the same argument works. The difference lies in the power to make bold decisions that will result in social change. And here I think that Twitter has more immediate power to effect major change than the government of Uruguay (or perhaps any other government).
Governments are not always free to make fast, bold decisions for social progress and development, even if they want to - they can be restricted by laws, by bureaucracy, by judges, by religion, by national and international stakeholders, by the media, and by just about every special interest group and internal obstacle you can imagine. Incremental change (in the form of compromises) is one way for governments to improve the present situation while laying the foundations for bolder social change. Twitter, on the other hand, has far less restrictions - when it boils down, it's about balancing their own values (free speech) with their objectives (growth). And Twitter's leadership is empowered to make bold decisions. So why compromise?
It seems to me that social progress and development rarely come out of the blue: compromise lays the foundations. Just as Uruguay's maternal heath program is compromising to improve the current situation for women and lay the foundations for bolder changes, so too are the social media companies who operate in countries that limit free speech making their own compromises, laying the foundations for powerful companies like Twitter to be bold.
Of course I'm not suggesting that Twitter is obliged to take responsibility for delivering international social progress in the form of free speech. But its global reach and impact are massive. Its leadership has serious negotiating power and can make bold decisions. Twitter's might is so powerful that it could succeed, instead of just laying more foundations. Foundations are important, of course, but at some point, someone needs to start building the house.
I think the difference between Uruguay's abortion law and Twitter's censorship plans is whether it's right to conclude that 'battling for all or nothing is the best way for nothing to change'. Opportunities to battle for all or nothing, and win all, don't come around every day. I'm told there are currently too many powerful barriers to completely repeal Uruguay's abortion law, and the maternal health program seems to be laying foundations and working as an effective compromise for now - and bravo to them. But in terms of free speech, perhaps Twitter could have battled and won more.
Follow Dr Layla McCay on Twitter: www.twitter.com/LaylaMcCay